Children and high blood pressure
Evaluating blood pressure in ER may help docs detect health problems in children
By Matt Galnor
More than half of children admitted to an urban Florida pediatric emergency department had elevated blood pressure, according to a study published in the journal Pediatric Emergency Care.
Elevated blood pressure is often a sign of kidney or other health problems in children. Evaluating the readings thoughtfully and ordering further tests could be a key to diagnosing a serious problem, said Phyllis Hendry, M.D., an associate professor in the department of emergency medicine at the UF College of Medicine-Jacksonville and one of the authors of the study.
Researchers looked at the charts of nearly 1,000 patients admitted to Shands Jacksonville over a 13-month period in 2007 and 2008. Researchers were only expecting to see about 100 patients with elevated triage blood pressure but found more than 500, Hendry said. More than 20 percent had severely elevated levels, said Hendry, who also serves as assistant chair of research for the emergency medicine department.
The study also found that elevated blood pressure was recognized on the medical record in only a small percentage of cases.
“In adult emergency patients, we are very focused on blood pressure and abnormal values are clearly defined,” Hendry said. “In children, it’s easy to dismiss a high value because often they are anxious, crying or in pain. There are a number of things that can affect blood pressure.”
But as hypertension among children is on the rise — now in 5 percent of American youth, up from 1 percent in the 1970s and 1980s — the emergency department can play a larger role in flagging potential problems. The standards are based on age, weight and even height — a measurement not usually taken in pediatric emergency departments.
Hendry said it is difficult to know how much weight to give the statistics because of the lengthy list of variables that go into calculating a “normal” blood pressure for a child.
“You can be transitioning from examining a premature baby that weighs 3 pounds to a 300-pound adolescent, so what is normal blood pressure supposed to be?” Hendry said.
Standards are also based on measuring the blood pressure three times and taking the mean of the three readings, which is not practical in an emergency department.
Emergency department blood pressure is also often given little credence because children are upset and scared, which could skew the numbers, Hendry said. However, the study found the pain level of the child was not associated with blood pressure elevation, nor was the race of the child, Hendry said.
If patients are in the emergency department for several hours or more, their vital signs are usually checked again or at discharge. Researchers say if a child’s blood pressure remains elevated, physicians should suggest a follow-up appointment with the child’s primary care physician within a few weeks.
As hospitals move toward electronic medical records, ways to flag high blood pressure in children would be valuable, said Arno Zaritsky, M.D., senior vice president of clinical services at Children’s Hospital of The King’s Daughters in Norfolk, Va., and a medical consultant for the American Heart Association.
“I think the take-home is maybe we should have a process as part of sending them home that we check the blood pressure later to make sure that it does come down,” Zaritsky said.